Respiratory medicine: pneumonia severity: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: pneumonia severity

Sample item

A 72-year-old man with pneumonia is confused. His blood urea is 9 mmol/L, respiratory rate 32 per minute and blood pressure 85/50 mmHg. What is his CURB-65 score, and what does it imply?

A2, suitable for outpatient treatmentB4, a moderate risk suitable for a general ward onlyC5, a high mortality risk needing hospital admission and assessment for intensive careD3, suitable for oral antibiotics at home

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. 5, a high mortality risk needing hospital admission and assessment for intensive care

CURB-65 gives one point each for new confusion, urea above 7 mmol/L, respiratory rate 30 or more, systolic pressure below 90 or diastolic 60 or less, and age 65 or more. This patient scores on all five items, giving 5. Scores of 3 to 5 indicate severe pneumonia with a high mortality risk, and 4 or 5 warrant consideration of intensive care.

Option by option

A. 2, suitable for outpatient treatment
A score of 2 would warrant short-stay admission, and does not reflect his five criteria.
B. 4, a moderate risk suitable for a general ward only
The patient meets all five criteria, not four, and a score this high needs ICU assessment.
C. 5, a high mortality risk needing hospital admission and assessment for intensive care (correct)
Correct. All five criteria are present, giving the maximum score and a high risk of death.
D. 3, suitable for oral antibiotics at home
The score is not 3, and a score of 3 or more is not safe for home management.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, 5, a high mortality risk needing hospital admission and assessment for intensive care. CURB-65 gives one point each for new confusion, urea above 7 mmol/L, respiratory rate 30 or more, systolic pressure below 90 or diastolic 60 or less, and age 65 or more.

Why is "2, suitable for outpatient treatment" not the answer?

A score of 2 would warrant short-stay admission, and does not reflect his five criteria.

Why is "4, a moderate risk suitable for a general ward only" not the answer?

The patient meets all five criteria, not four, and a score this high needs ICU assessment.

Why is "3, suitable for oral antibiotics at home" not the answer?

The score is not 3, and a score of 3 or more is not safe for home management.

What concept does this question test?

It tests Respiratory medicine: pneumonia severity in General Medicine. This patient scores on all five items, giving 5. Scores of 3 to 5 indicate severe pneumonia with a high mortality risk, and 4 or 5 warrant consideration of intensive care.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: pneumonia severity?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.